• Admission
  
• The staff
  
• Surgery
  
• Abdominoperineal resection
  
• Ostomy
  
• Hospitalization for infection
  
• Chemotherapy
  
• Radiotherapy
  
• Thriving versus surviving
  
• Discharge and departure
  

Admission

After admission, a volunteer may be assigned to stay with you briefly until you've arrived in your room and become oriented, especially if you're having surgery.

Once you have arrived in your room, the nursing staff will take control and prepare you for whatever care you will need. They'll check vital signs such as pulse and temperature, and may start an intravenous line (IV) for administering drugs, and may help you with one final enema if your surgery is later that day or early the next day. You'll probably find that nurses will return a hundredfold any small effort you make to be friendly and kind.

Ask now about the meal menus, as there is usually a delay in getting meal preferences to newly admitted patients.

If you're being admitted for most procedures, you may be sharing a room with someone else. If you have rectal cancer and you're scheduled to be treated with a radioactive substance, you'll most likely be given a private room immediately or very soon.

The staff

The nursing staff is the first group you're likely to encounter in your hospital stay, but they're just one group of a confusing array of medical personnel you'll meet.

Note that you may refuse care administered by any staff member with whom you don't feel comfortable, and may ask for a more experienced person to attend to you.

Nurses

Hospital nurses will provide most of your care:

• Nurses' aides and licensed practical nurses (LPNs) will help wash you, help you in and out of bed, make your bed, and perform simple nursing tasks such as checking your pulse and temperature. LPNs, but not nurses' aides, have completed vocational training and may provide medication.
• Registered nurses (RNs) have earned a college degree in nursing and passed a licensing examination. RNs are able to provide more complex and critical medical care than LPNs, such as changing wound dressings, communicating with doctors, starting IVs, and administering IV medications.
• Nurse practitioners or clinical nurse specialists are RNs who have undertaken extensive additional training and are licensed to provide many of the same services that doctors provide. In some states they are able to prescribe drugs under the auspices of a physician. In some hospitals or clinical settings they may perform simple surgeries and procedures, such as lancing abscesses.
• Head nurses and nurse managers are in charge of other nurses, entire floors, or patient centers. Although all nurses now face the additional burden of administrative work that deprives them of time they prefer to spend with their patients, head nurses and nurse managers usually handle administrative issues exclusively, and seldom provide patient care unless staffing is inadequate.
• Enterostomal therapists are nurses specially trained to help those who will be having a stoma surgically created. A stoma is a temporary or permanent opening in the abdominal wall to allow waste to exit the body. Your surgeon will discuss with you whether your surgical procedure will include temporary or permanent ostomy.

Doctors

In teaching hospitals, you'll encounter the full spectrum of doctors in various stages of training. In some community hospitals, you'll encounter just residents and attending physicians. In other community hospitals that have agreements with nearby medical schools, you may find an amalgam of the two systems. Doctors in various stages of training include:

• Medical students who have completed four years of college and are undertaking four additional years of medical school. Medical students do not treat patients, although they may accompany an attending physician on rounds, and the physician may elicit their opinions.
• Interns, also called first-year residents, or postgraduate year-one students, have completed four years of medical school and are in the first year of three to six years of primary specialty training. They will not give you care unless supervised by much more experienced personnel, such as the attending physician or a more experienced resident, but that supervision may be distant. If you prefer not to be treated by an intern, say so.
• House officers (once called residents) may be postgraduate year-two students, postgraduate year-three students, and so on. These physicians are still receiving primary training that can last from three to six years, depending on the field.
• Fellows, or teaching fellows, have completed their six years' primary training, and have undertaken three years of additional training in a subspecialty.
• The attending physician is in charge of all fellows, residents and interns. In university hospitals, she is likely to be a faculty member. In community hospitals, she is hired to oversee patient care in her area of specialty based upon her reputation in the medical community.

I was in the hospital for chemotherapy and a very nervous looking medical type--student? intern?--tried to access my port and couldn't. After several tries the sweat ran down his face and he gave up.

Later that evening another guy in a white coat showed up. With my newfound bravery, I asked him, "Do you know how to access one of these things? Have you ever done it before?"

"Not only have I accessed them," he said, "I've installed hundreds."

He then proceeded to put the needle in with one quick jab--no pain, no anxiety. So much for my insisting on knowing who knows what they are doing!

Surgery

The most common surgery for colorectal cancer is laparotomy, an incision into the abdomen and pelvis to remove some or all of the colon or rectum, perhaps nearby organs that might be entangled with cancerous tissue, one or more lymph nodes in the abdomen or pelvis, and a portion of the liver if it has been invaded. Some procedures to remove part or all of the colon or rectum require creation of a temporary or permanent opening in the abdomen, called a stoma, through which feces can exit.

Other surgeries for colorectal cancer include:

• Rejoining of the intestine and removal of a temporary stoma.
• Removal of abnormal tubes called fistulas that form between two organs as a result of disease or of the healing that follows some surgeries.
• Removal or bypassing of intestinal blockage.
• For rectal cancer, placement of tubes for later containment of radioactive substances.
• Biopsies of lung, liver, or kidney, although these biopsies frequently are done as outpatient procedures.

You'll receive extensive instructions, meet with the anesthesiologist, and be monitored to ensure that no food is taken before surgery. Certain tests such as CT scans, ultrasound, or MRI may be repeated to precisely target tumors that need to be removed.

You'll meet with your surgeon to discuss what will be done during surgery. If the surgeon is planning to create a stoma, your abdomen will be examined to choose the best place for the stoma, taking into account the natural folding of your skin, the kinds of physical activity you enjoy, the part of the intestine that must be removed, and so on.

If you do not have a central catheter, an IV will be placed in your arm or hand--perhaps upon admission, one day before surgery, or directly before.

Just before surgery

The risks associated with this surgery will be explained to you, and you will be asked to sign a consent form.

If your surgery could affect the intestines in any way, you will be asked to fast for 12 to 18 hours before surgery. You may be instructed to use enemas or laxatives beforehand.

The site of the incision will be cleaned, shaved, and possibly marked for proposed incision lines and stoma placement, if ostomy is anticipated. If you're especially hairy, ask that a large area be shaved, including the IV site on your arm. Sticky bandaging can hurt terribly when it's removed if it pulls against hairs that have not been shaved.

If you're feeling nervous, ask for a sedative. The hour or two directly before surgery are likely to be the most tense.

If you have had nausea associated with anesthesia in the past, tell the anesthesiologist.

You may be asked to walk into the surgical suite, or you may be taken in on a rolling bed and shifted to the table. A rubber oxygen mask may be placed over your face to check for fit. Your arms may be positioned on armrests that facilitate giving medications by IV. A breathing tube will be inserted from your mouth to your upper lungs, but this intubation will be done after you're asleep, as may the insertion of a urinary catheter and a nasogastric tube to keep your bladder and stomach empty. Coating your eyelids with a lubricant while you're asleep to keep them from drying may also be done, as presurgical medication may include drugs to dry body fluids and reduce bleeding.

And now, the good part: you'll fall asleep, and you won't care what they do.

Surgical recovery

When you reawaken slowly, you'll be in the recovery room. You may notice that you've acquired rubber support stockings or a series of tubes attached to various body parts--but you won't care too much, because you'll be groggy for several more hours. You may also notice that your hearing returns first, well before sight does, and that you can remember odd or humorous things the staff said as the surgery was ending.

You may feel some pain too, upon waking. Be sure to make clear your need for pain medication as soon as you are awake and are experiencing pain, as excessive pain can interfere with healing. The nursing staff will not administer painkillers, though, until you're clearly awake, in order to avoid overdosing a patient possibly still affected by anesthesia. This means that, if you're feeling pain, you must tell them distinctly as soon as you are able. Groaning, for example, is not considered a clear indicator that you're awake. The nurses will attempt to get you to speak to be sure you're awakening normally.

Eventually you'll be returned to your room, but the first 24 hours may be a hazy memory if you've received general anesthesia. If you received a sedative instead of general anesthesia, you'll be groggy, too, but it will resolve more quickly than the aftereffects of general anesthesia.

Additional pain medication from day one will be given freely if you ask. Most patients find they need a minimum of three days of strong pain medication after abdominal, pelvic, or rectal surgery. Many hospitals now use patient-controlled infusion (PCI) pumps, as they yield a more even dose--about twenty microdoses per hour--than pain medication given by tablet or IV. PCI pumps also will yield a limited amount of additional medication if the patient pushes a button on the pump for this purpose. Don't worry about overdose. The pump won't allow it. The minicomputer within the pump counts the number of patient pushes so that the staff will have a good idea of your need for pain medication.

If you feel any nausea at all, even transient nausea, tell the nursing staff immediately. Vomiting, especially with a fresh incision, is a very unpleasant experience.

Use of anesthesia and painkillers slow the activity of various organs, including the kidneys, urinary bladder, and intestinal tract. Your liquid and solid waste will be monitored after surgery until the staff note that your body systems are once again functioning as they should.

For the first few days after intestinal surgery, the contents of your stomach will be emptied by a nasogastric pump to ensure that no food or waste travels through the intestine. This is necessary because the intestine is a sulky organ that stops working after even a small injury. When the doctors and nurses begin to hear gas rumbling in the intestine, they know that its natural contractions, called peristalsis, are resuming, and that the nasogastric tube can be removed and a liquid diet attempted. If liquids stay down and do not cause pain, fever, or abdominal swelling (all signs of intestinal leakage, a serious complication of intestinal surgery), soft foods such as Jell-O can be added. If this succeeds, solid food can be introduced gradually.

Do the physical therapy, walking, coughing, or breathing exercises you're given as soon and as often as possible. Exercise will help you heal more quickly, and will reduce the chance of developing complications such as the form of pneumonia that's associated with lying flat for long periods. If you have an abdominal incision, hold a pillow against it for comfort while you cough.

Max describes how successfully he has recovered from surgery:

I had a colon resection during which they took seven lymph nodes. A trace of cancer was found in four. I had very little pain after surgery. In fact, I played two rounds of golf five weeks after surgery. My doctor stressed the fact that I should not be in pain. He encouraged me to walk immediately after surgery and I was up to about one mile by the third week. I only needed pain medication for about two to three days after I left the hospital. Believe me, I am a weenie and would have been yelping if there had been pain.

If, after surgery, you have trouble getting in and out of bed, ask the nursing staff to tie something rope-like to the footboard so you can experiment with using arm muscles instead of abdominal muscles to pull yourself up and, especially, to lay yourself back down.

I sailed through the surgery and was home four days later. I had the morphine pump, which worked wonderfully. Had an uneventful, rapid recovery. The surgeon was pleased that the presurgical radiation therapy had completely shrunk the tumor. Three weeks later I began six months of chemotherapy.

Abdominoperineal resection

Your surgeon will do his best to preserve tissue in the anus and rectum that control bowel movements, but at times the location, aggressiveness, or spread of the tumor makes sparing this tissue unsafe. Removal of all anal and rectal tissue, and the supporting structures near the rectum and anus, is called abdominoperineal resection. For rectal cancer, it might be the only surgery needed; for certain colon cancers, it's generally considered one half of the procedure, the other half being removal of part or all of the colon through an opening in the abdomen.

Two techniques exist for repairing the damage caused by removing this much tissue: a patching together of the tissue that remains, or packing the open wound as if it were an abscess, and waiting for new tissue to regenerate and fill the open area over several weeks. Today, most experts believe that the open wound should be patched with surrounding tissue as best as possible, instead of being left open to heal.

Because so much tissue is removed from such a sensitive surface area, significant and lengthy discomfort may accompany recovery from this surgery. If you're having difficulty sitting, be sure to tell the doctor and the nursing staff so that adequate levels of pain medication are supplied, and other aids are made available to you, such as sitz baths.

This pain may persist for some time after you've left the hospital. Some colon or rectal cancer survivors consider this part of post-surgery recovery more painful than an abdominal incision.

One survivor of ulcerative colitis that resulted in a stage I tumor describes his surgical experience:

Before surgery I tried to stay in shape and exercise. I had an advantage that I wasn't on any medication prior to the surgery. I think it made recovery an easier experience for me. It probably made the surgery a more successful one, too.

The days before surgery we came up with our own top 10+ list of why I didn't need my colon. I had printed it to take with me to the hospital. I realized I had forgotten it before we got out of the neighborhood. I went back and got it. I gave it to the nurses as I was going into surgery. That got a good laugh. I was pretty nervous. I was told that they posted it down by the operating rooms. We managed to come up with quite a few good and funny reasons why I wouldn't need the equipment I was born with.

A funny thing happened while preparing for my stay in the hospital: I'd decided to get a room in the deluxe wing of the hospital to make this painful experience better. The fancy room had several advantages: private nursing, fax machine, early American decor, but its best offering was the gourmet menu--and I couldn't eat any of it! By the time I was able to eat, it was time to discharge me.

The surgery went very well. No nerves were damaged, so my sex life is as good now as it was before surgery. I didn't know that I had cancer until they had biopsied the removed colon and all points in between. A tumor was found contained in the interior colon wall. All the biopsies and colonoscopies hadn't seen this particular location. The lymph nodes were free of cancer. It's a good thing I had surgery when I did.

Sitting was a problem for a while, until the area where my rectum used to be healed. I had painkillers for the first few days. The area that hurt the most was my abdomen. My surgeon said I would feel like I had been hit by a truck, and I did. I was sore and stiff in all the places they operated. It took a couple of months before I was really moving normally. I was up and ready to walk in the malls as soon as I got home. The problem was I got tired pretty quick.

Ostomy

You might be told before surgery that an artificial opening called a stoma will be created in your abdomen. You might be told that it definitely will not be--or you might be told that the surgeon just won't know until the abdomen is open, and the full extent of disease can be evaluated.

Just after surgery and for a day or so afterward, you may be too groggy and sore to remember or to care whether you have a newly created stoma. While you're recovering, the nursing staff will do the initial care for you, until you're willing and able to do it on your own. Eventually you'll be visited by a nurse--an enterostomal therapist, it is hoped--who will help you learn how to clean the skin around the stoma, change the bag or patch, and irrigate, if necessary. The stoma itself is self-cleaning, as it is internal epithelial tissue that continually produces mucus.

If your hospital does not have an enterostomal therapist, contact the United Ostomy Association at (800) 826-0826 for help. Colorectal cancer survivors report both very good and very bad experiences regarding training in ostomy care from nurses who are not specialists in enterostomy.

The United Ostomy Association has trained visitors who will talk to you and help you feel better about what you've been through. Usually you don't have anyone to talk to while you're in the hospital who's actually gotten an ostomy. The biggest thing is that you need a live person to stand in front of you, going, "Hey! There's life after surgery. You, too, can look and act like nothing's different: at the spa, snorkeling, laying on the beach--no more issues than I have sitting in the office all day."

Your first sight of your stoma may be profound, insignificant, or an anticlimax. You may feel extremely relieved that cancerous tissue is removed, and consequently you may feel grateful that ostomy saved your life. You may be afraid to look at the stoma--and then relieved after you have. You may be horrified. You may be sad or angry, or have feelings of great loss. You may feel dirty, or you may be afraid that others will think you are. You may feel much more interested in your abdominal incision, which may be painful, than in the stoma. If all anal and rectal tissue was removed--abdominoperineal resection--you may be fully occupied with doing basic things, like sitting without pain, and inspecting the stoma will wait for later.

Expect the stoma to look bright red and a bit swollen at first. As time passes, it will shrink a bit, but distinct red coloration and continual production of cleansing mucus are characteristic of a healthy stoma.

My ostomy is on the side of my navel, two inches to the right, and two inches down. Mine's an ileostomy. It's in that general location because there's a muscle wall there that stays pretty flat almost all the time. It's a functionality point of view: the appliance glues on. You need a flat surface for this, because what is called the wafer is a little bit flexible but it usually doesn't bend in half. It'll bend a little, but the bottom line is that the flatter, the more constant the surface that doesn't flex too much, the better luck you'll have with the appliance staying on.

Expect the surgeon to inspect your stoma and preen over the good job that was done. Surgeons have been perfecting ostomy since the days of ancient Egypt, and are happy when it's perfectly round, protruding just a quarter or a half-inch beyond the skin of the abdomen.

Hospitalization for infection

If you're being treated with chemotherapy for colorectal cancer, you might also need to be hospitalized to treat infection.

About seven to ten days after certain chemotherapies are given, it's common for your white blood cell counts to drop to dangerously low levels. Without adequate numbers of white blood cells, the body cannot fight infection.

If you're hospitalized for infection, most likely you'll be placed alone in a hospital room, a procedure called isolation. The air may be scrubbed with a high-energy particulate air (HEPA) filter or controlled via laminar airflow.

Although some studies have shown that infection during neutropenia most often arises from pathogens already within the patient's body, restriction of visitors, gifts, and certain foods will be enforced. For example:

• All who enter will be expected to adhere to safety measures such as vigorous handwashing and covering the mouth with a mask.
• Gift plants with pollen-bearing stamens, potting soil, or silk plants with mossy, fungus-bearing camouflage at their base may be returned or held outside your room.
• Certain foods, such as fresh fruit or yeast breads, may be denied to you.

Isolation procedures may seem odd--after all, you're already infected--but the goal is to prevent your coming in contact with additional and potentially very serious infectious agents.

You'll be given oral or IV antibiotics, antivirals, or antifungals, depending on your symptoms and the results of various cultures. You may also be given drugs to help you grow new white or red blood cells.

You'll stay in isolation until your white blood cell counts rise and the infection is bested, either by the antibiotics you're given, or by the infection-fighting ability of your own increasing white blood cells.

Chemotherapy

Some chemotherapies are given in the hospital in order to simultaneously administer additional agents that offset the damage to healthy organs, or to monitor the state of affected organs. Examples are the use of Mesna to prevent damage to the bladder when the anticancer agent cyclophosphamide is used, and the administration of intraperitoneal chemotherapy.

The procedures used will vary, of course, depending on the agents being given, but most likely you can expect an IV line to be inserted if you don't have a permanent venous catheter, and you'll receive frequent and perhaps somewhat embarrassing attention from nurses regarding normally routine and personal phenomena such as blood pressure, how much urine or feces you've passed, whether bowel movements are painful, and so on.

If copious oral or IV hydration accompanies your treatment, unless a urinary catheter is in place, you'll be compelled to rise frequently to urinate, and you may become quite tired owing to lack of a full night's sleep.

For certain subtypes of colorectal cancer that might have escaped from the primary tumor site and spread along the lining of the abdomen, injections of chemotherapy directly into the abdominal cavity, called the peritoneal cavity, might be used. This treatment is called intraperitoneal chemotherapy.

Access to the peritoneal cavity is achieved either by implanting several tubes and drains during the surgery to remove the tumor, or during a subsequent surgery, or by insertion of a catheter each time the treatment is given.

Once tubing is in place, the administration of anticancer drugs may begin as early as during surgery and continuing the day after for five days while you are still hospitalized. The drugs are infused through the tubes, left in place for many hours, then drained.

The medical staff administering the chemotherapy also may do imaging studies such as CT scans during or after infusion to be sure that all areas of the peritoneum are exposed to adequate amounts of anticancer medication.

Radiotherapy

For those with rectal cancer, several types of radiation therapy usually require a hospital stay. In addition to the more common treatment of rectal cancer with external beam radiotherapy, radioactive substances also can be used by:

• Implanting a radioactive material embedded in wires, seeds, capsules, or needles permanently into rectal and surrounding tissue during the surgery that removed the primary tumor or, less frequently, in a second surgery (interstitial radiotherapy).
• Placing a small container housing a radioactive substance temporarily inside the rectal cavity (brachytherapy).

This means that you might be hospitalized for a surgery to implant tubes or small containers that will contain the radioactive substance.

If your implants are not permanent, a stay in a lead-shielded isolation room might be necessary while radioactive materials are inserted, left in place for a few minutes or a few days (depending on the dose required), then removed. Containment measures will be engaged while the radioactive substance is being handled, and while in place. Visitors will be limited, kept at a distance of six feet, or forbidden altogether. Although hospital staff will provide you with all the care you need, for their safety during this time they must minimize their contact with you.

In order to avoid having implants shift, you might be asked to stay in bed while the implants are in place.

Once the radioactive substance is removed, you are no longer a risk to others.

When treatment has ended, implants might be either left in place or removed. Often, implants, tubes, or canisters that are temporary can be removed with little or no pain at the end of treatment, but you should tell the hospital staff if you are experiencing pain or discomfort during or after removal.

The rectum, perineum, and parts of the internal pelvis might be sore for days or weeks following radiation therapy.

Thriving versus surviving

Very few people look forward to being hospitalized. The goal is to make the stay short and successful by remembering that ultimately it's your life, and, in spite of perhaps temporarily diminished capacities, you're still very much in charge.

Here are several key points:

• Read your medical chart. Ask questions if anything is unclear. Ask for definitions of terms the staff may use, such as NPO (noli para os, or nothing by mouth). If you're not well enough to do this, have a friend or relative do so.
• Verify all drugs and treatments given to you. Ask about oral medications before swallowing, and read the contents of the IV bags on your pole. If you're not well enough to do this, have a friend or relative do so.
• Tell the nursing staff right away if something seems wrong. Don't let seemingly simple things, like feeling constipated, become major problems.
• If you are permitted to get out of bed, move about your room and the corridors as much as possible, especially if you've had surgery. You'll heal faster and diminish the likelihood of serious complications if you move about. If you feel too bad to get out of bed, flex your arms and legs a good deal. If you're neutropenic, ask if you and your IV pole can cruise the corridors wearing a mask and surgical slippers. (If you feel conspicuous wearing a mask, you might try making a prank of it by adding a toothy grin with waterproof ink.)

Additional ideas for dealing with your hospitalization follow:

• If you're not on a restricted diet, coerce friends and loved ones into bringing you your favorite foods. This will make you feel better, and will help those friends who would otherwise not know what to do feel useful and loving. Most hospitals now permit outside food to be brought into the patient's room, a change more in keeping with the European model of families caring for patients. Bringing food will help family members feel a part of your care if they are not permitted to do much else; for instance, if their time with you is restricted during certain radiation therapy treatments.
• At first, take pain medication on schedule if it is prescribed, even if you think you won't need it, because you'll heal better, and will be more mobile, if pain is adequately controlled. As time passes, you'll be a better judge of how much painkiller you really need.
• Befriend the staff. They'll repay you tenfold for your kindness. It's surprising how much can be asked of others if it's done in a nice way.
• If you're a caretaker, pitch in and do what you can to help the nurses help your loved one. Stay overnight if at all possible; if the staff decline, insist.

When my husband was hospitalized after his abdominal surgery, he was on morphine which slowed his ability to urinate. Often during the night he needed to use the john, and he and his IV pole would stand there in front of the toilet doing not much of anything for ten or fifteen minutes. Because I stayed with him overnight, I was able to help him in and out of bed repeatedly without his calling a nurse.

Discharge and departure

Discharge may be an anticlimax after your hospital stay, but you should use this time to have the staff answer all of your questions about aftercare. Make sure you understand:

• First, whether you're really going to be able to handle being at home. Hospitalization times vary based on the patient's condition and the type of insurance in effect. If you feel you need to stay longer in the hospital but your insurance policy limits your stay unless the doctor requests otherwise, be sure to make your needs known to your doctor and the nursing staff.
• If your spleen was removed, you should discuss with your doctor the need to be revaccinated every few years with pneumococcal, Haemophilus influenzae type B, and meningococcal vaccines. The risk of being overwhelmed by agents capable of producing encapsulated infections is higher in those lacking a spleen.
• The medications you may be taking. When you are discharged you probably will be given a prescription for oral pain medicine, for example.
• Whether the hospital pharmacy can fill your prescriptions before you leave. If not, get the doctor to phone your pharmacy, or get a family member to fill them beforehand.
• How to care for your incision if you've had surgery.
• How to care for your stoma if you've had one created.
• What side effects or aftereffects you should watch for that might signal a problem.
• What follow-up appointments should be scheduled, and any diet restrictions.
• Your bill. Always ask for an itemized bill.

After surgery it would be best to set up a bed downstairs if you can. We have a half bath downstairs, so the second day home I opted for a sponge bath downstairs. After that, as long as I went slowly, stairs were fine.

Any way that you can make it easier for yourself, go for. I slept on the sofa downstairs because it's cooler, and because I was worried if my hubby tossed and turned too much my catheter, inserted at the same time as resection surgery, would get jabbed by an elbow! After three or four days I did move back upstairs and it was no problem--really.

But if you can set up downstairs very comfortably, that is probably best in the beginning when you first get home.

The person helping you with your trip home should bring the car to the exit in advance, and should make as many preliminary trips as necessary to remove your personal effects and gifts from your room, perhaps warming or cooling the car in advance as well. Most important, though, is that by leaving you for last, your escort can devote attention to you alone as you're exiting. This is a useful arrangement because you may need help getting into the car, for example, but the hospital's assistance and liability end at the door.

Use the restroom before you leave, even if you think you don't need to. Even a small amount of stress on the trip home or cold temperatures, for example, can cause the brain to signal the bladder or bowel to empty.

Most hospitals have a regulation stating that you must be escorted to the door in a wheelchair. This reduces the chance that patients, possibly weakened by extended bed rest, will pass out or suffer a mis-step while exiting. While many people leaving the hospital find using a wheelchair embarrassing, it safeguards both you and the hospital. Fortunately or unfortunately, you'll have plenty of chances to prove you're mobile again once you're out the door.

After many surgeries, one is restricted from driving for several weeks. Certain activities such as climbing stairs may also be restricted. Full recovery may take as long as six weeks and may include pronounced fatigue.

After radiation therapy, you may be surprised to feel more tired over time instead of less tired. This is normal and will reverse eventually. The areas irradiated may feel sore or burnt for days or weeks after therapy.